Premenstrual Syndrome (PMS)

Premenstrual Syndrome (PMS) is a collection of physical and emotional symptoms that are related to a woman's menstrual cycle. Symptoms generally occur 5 - 10 days prior to the start of the menstrual period and are severe enough to interfere with your life in a significant way.

Symptoms of PMS include food cravings, breast tenderness, feelings of sadness, anger, irritability, and mood swings.  Emotional symptoms must occur in a regular pattern in the two weeks before the start of a period in order to diagnose PMS. If you feel blue or down in the dumps and these feelings last longer than the week before your period, it's probably not related to PMS and you could be suffering from depression or anxiety.  If this is the case, then it is recommended that you see a therapist or counselor.

PMDD: Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS. Although regular PMS and PMDD both have physical and emotional symptoms, PMDD causes extreme mood shifts that can disrupt your work and damage your relationships. Three out of four menstruating women may experience a mild form of PMS. Up to 8 percent of women with PMS have such severe symptoms that it meets the criteria for PMDD.

Causes and risk factors for PMS and PMDD include:

• High caffeine intake
• Stress
• Increasing age: most women affected are in their late 20s and early 30s
• Depression
• Anxiety disorder
• Having a mother with a history of the disorder
• Lack of exercise
• Alcohol abuse

The cause of PMS and PMDD is not clear. Underlying depression and anxiety are common in both, so it's possible that the normal physical changes that trigger a menstrual period somehow make mood disorders much worse. Studies show that hormone changes in a woman's menstrual cycle also play a role.  Some women are more sensitive to hormone changes than others even though their blood levels are the same as in women who don't have PMS or PMDD.

Symptoms

The most common signs and symptoms include fatigue, bloating, irritability and anxiety.  Other symptoms include the following:

• Sadness, hopelessness or feelings of worthlessnes
• Tension, anxiety of feelings of "edginess"
• Mood swings and frequent crying
• Irritablility, anger and conflict with family, coworkers or friends
• Trouble concentrating
• Fatigue or lack of energy
• Food cravings
• Problems sleepiing
• Feelings of being overwhelmed or out of control

• Breast tenderness, joint or muscle pain or weight gain

Signs and Tests

There is no unique physical exam or lab test that can diagnose PMS or PMDD.  Your health care provider will take a careful history, do a complete physical exam and may order lab tests to rule out an underlying disorder.  To help establish a premenstrual pattern, your provider may have you keep a diary to record your signs and symptomms on a calendar for at least two menstrual cycles.  Note the day that you first notice PMS symptoms, as well as the day they disappear.  Also be sure to mark the day your period starts and ends.

Diagnosis

To be properly diagnosed with PMS or PMDD, usually at least five symptoms need to be present. Symptoms typically begin 10-14 days prior to the start of menstruation. They begin to decrease once menstruation begins. Symptoms that occur at other times during the cycle suggest other underlying mood or anxiety disorders.

Treatment

Symptoms can usually be treated with lifestyle changes and over-the-counter medicine such as Ibuprofen or aspirin to relieve menstrual cramps and breast tenderness.  Suggestions are as follows:

Education

You will be better able to deal with your symptoms if you can relate how you're feeling to your menstrual cycles, knowing that you will feel better once your period starts. Knowing when to expect your PMS symptoms and learning how to cope with them may help relieve the stress and irritability you feel before your period.

Lifestyle Changes

• Fit in exercise. Do aerobic exercise (such as fast walking, running, dancing, or jumping rope) for 30 minutes a day, 4 to 6 times a week.
• Get plenty of sleep. If you're a teen, you need about 9 hours of sleep each night.
• Maintain a regular schedule of meals, exercise, and bedtime.
• Keep stress to a minimum. If possible, try to schedule events that you think could be stressful during the week after your period.
• Avoid alcohol. Drinking alcohol before your period can make you feel more depressed.

• Relaxation techniques. Try yoga or meditation.

Nutrition Changes

• Eat complex carbohydrates that are high in fiber (such as whole grain breads, whole wheat pasta, and high fiber cereals instead of white bread, white pasta, and sugary cereals).
• Cut back on sugar and fat. Even though your body may be craving sweets or fast foods that are high in fat, try to limit these foods since they may add to your PMS symptoms.
• Don't eat foods high in salt (sodium) for the few days before your period. For example: avoid canned soups, Chinese food, hotdogs, and pizza, which are very high in sodium. Cutting down on sodium may help to control bloating by lowering the amount of fluid your body retains.
• Drink plenty of water.
• Cut back on caffeine. Reducing the amount of caffeine you eat and drink (soda, coffee drinks, and chocolate) may help you feel less tense and can ease irritability and breast soreness.
• Try eating up to 6 small meals a day instead of 3 large ones and include a balance of foods and nutrients (protein, carbohydrates, fruits/veggies, and healthy fats) at each small meal. This will help keep your blood sugar levels even, which will give you energy that lasts.
• Don't forget dairy! You should eat or drink 4 servings of high calcium foods (such as milk, fortified OJ, or soy milk) each day.
• Vitamin and mineral supplements. Studies show that a calcium supplement of 600 mg twice daily may decrease symptoms of irritability; Magnesium 400 mg each day may reduce fluid retention and breast tenderness; Vitamin B6 50 mg per day as well as Vitamin E 400 IU of d-alpha-tocopherol have both shown benefits for women with PMS.

• Herbal remedies. Chasteberry has been shown to help with symptoms of PMS in some small studies.

Medications

• Birth control pills: PMS and PMDD occur at about the same rate whether you're taking birth control pills or not.  However, some women experience relief from their symptoms when they begin taking birth control pills.  (Some women, on the other hand, feel worse).  If the birth control pill is found to be helpful, you may be prescribed the birth control pill in such a way as to avoid having a menstrual period every month.  Taking the pill continuously prevents the usual cyclical hormonal changes that can contribute to PMS or PMDD symptoms
• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) are a highly effective treatment for the symptoms of PMS and PMDD. Between 60 and 75 percent of women with PMDD improve with an SSRI. Taking the SSRI only during the second half of the menstrual cycle may be sufficient to alleviate symptoms.  If not, then taking it daily may be indicated to obtain full relief.  The medication should be taken for at least two menstrual cycles to determine if it's working for you.
• Cognitive behavioral therapy (CBT) may be used either with or instead of antidepressants. During CBT, you have about 10 visits with a mental health professional over several weeks.
• Non-steroidal anti-inflammatory drugs (NSAIDs): Taken before or at the onset of your period, NSAIDs such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, Naprosyn, others) can ease cramping and breast discomfort.

After proper diagnosis and treatment, most women with PMS and PMDD will notice a substantial decrease in their symptoms or at least a drop to tolerable levels. 

Remember, call your health care provider is your symptoms do not improve with self-treatment and are interfering with your daily life.